Forty years ago, the U.S. government took the bold step of making the landmark Runaway and Homeless Youth Act, or RHYA, the law of the land. RHYA is the only Federal law that highlights the need for and funds critical services for youth experiencing homelessness. In July 2014, Congress introduced the Runaway and Homeless Youth and Trafficking Prevention Act (S.2646), new legislation that, if enacted, would reauthorize and strengthen RHYA. With continued funding for street outreach, basic center and transitional living programs, RYHA provides critical services and support to runaway and homeless youth and plays an important role in the effort end youth homelessness by 2020, a goal set in Opening Doors: Federal Strategic Plan to Prevent and End Homelessness.

This week CSH, in partnership with the Washington Low Income Housing Alliance, published Creating a Medicaid Supportive Housing Services Benefit. In the white paper CSH lays out an easy-to-follow framework for states that want to create a Medicaid benefit to pay for the services in supportive housing. The framework consists of five action steps: 1) Determine benefit eligibility criteria; 2) Define the package of services to be delivered; 3) Align the state Medicaid plan; 4) Establish a financing and reinvestment strategy; and 5) Operationalize the benefit.

Ending youth homelessness means putting a system in place to do so in every community. Here, having a common purpose is a key ingredient. Luckily, at the interface of the child welfare system and the homeless response system, we should agree on a common purpose. The child welfare system wants to see successful transitions to adulthood, which includes all of the outcomes of the framework to end youth homelessness, including stable housing. The homeless response system is certainly eager to close what has been called a pipeline from child welfare to shelter, and to see youth in stable housing instead of outside a shelter door. We should not have to debate our shared purpose.

Many states are still opting out or remain undecided about whether to participate in Medicaid expansion. One factor these states might consider in evaluating or re-evaluating their decision to participate is the impact of Medicaid expansion on homelessness in their state. But the benefits don’t stop there. State budgets, hospitals, health care providers, and Americans in general also stand to gain from Medicaid expansion.

Not long ago, I sat in the same place that you are sitting, managing the Continuum of Care and leading our community's ten-year plan to end homelessness. You have challenging jobs to do and I know you are balancing many competing issues and priorities. I've been fortunate to visit communities that are making great progress, and to support and work with communities that still struggle. Now I would like to share some reflections on the lessons I've learned from you, my colleagues, in our mission to end homelessness. Thank you for listening and especially for acting.

Today I want to address chronic homelessness, which is the first goal in Opening Doors. We have fewer than 1,000 days to bring the number of people experiencing chronic homelessness to zero; every day and every minute counts. For people living with disabilities and disabling conditions, every day or minute spent on the streets is another day or minute spent struggling to survive. So this message is a call to action. I am reaching out to ask, are we doing everything we can do to end chronic homelessness by 2015? Here are the top-ten questions you and the leaders of your ten-year plan should consider (not likely to be picked up by David Letterman but hopefully useful nonetheless).